2025-11-14T10:49:30-06:00 2024-12-31 135565207 KPMG LLP 1212 NORTH 96TH STREET SUITE 300 OMAHA NE 68114 990 2024-01-01 263064869 NEBRASKA PEDIATRIC PRACTICE INC NEBR 4029556262 8200 DODGE STREET OMAHA NE 68114 ALAN TINGLEY MD 4029556262 2025-11-10 1 0 SOPHIE R KING P02233384 4023481450 2025-11-10 2024 2025-03-06 01:10:19Z CHILDREN'S SPECIALTY PHYSICIANS ALAN TINGLEY 8200 DODGE STREET OMAHA NE 68114 112430774 0 X WWW.CHILDRENSNEBRASKA.ORG X 2008 NE TO DEVELOP, PROMOTE AND MAKE AVAILABLE TO CHILDREN FROM OMAHA, NEBRASKA, AND THE REGION, CLINICAL SERVICES AND OTHER RELATED PROGRAMS. 12 4 324 5 0 0 141299 201315 98085848 111995110 38051 13694 227886 220655 98493084 112430774 1737000 2558179 0 0 111418198 126453546 0 0 0 55566071 62624871 168721269 191636596 -70228185 -79205822 19206110 22662520 19206110 22662520 0 0 X PROVIDES A MEANS WHEREBY THE RESOURCES, EXPERTISE, AND KNOWLEDGE OF THE PEDIATRIC SPECIALTY PHYSICIANS CAN BE MARSHALED TO DEVELOP, PROMOTE, AND MAKE AVAILABLE TO PATIENTS FROM OMAHA, NE AND THE SURROUNDING AREA, PEDIATRIC, ACADEMIC, AND CLINICAL SERVICES AND OTHER PROGRAMS AND ACTIVITIES RELATED THERETO IN ORDER TO ACHIEVE THE PHYSICIANS' COMMON GOALS OF IMPROVING THE MANNER, PROCESS, ENVIRONMENT, ACCESSIBILITY, TIMING AND OTHER FACTORS INVOLVED IN THE DELIVERY OF PEDIATRIC , ACADEMIC, AND CLINICAL SERVICES IN ORDER TO ADVANCE THE HEALTH OF THE CHILDREN WITHIN THE REGION. PROMOTE AND SUPPORT EDUCATIONAL AND TEACHING PROGRAMS IN CHILDREN'S HEALTH. 0 0 184439306 2558179 112215765 TO PROVIDE COLLECTIVE RESOURCES, EXPERTISE AND KNOWLEDGE OF PEDIATRIC SPECIALTY PHYSICIANS TO DEVELOP, PROMOTE AND MAKE AVAILABLE TO CHILDREN FROM OMAHA, NE AND THE SURROUNDING REGION, CLINICAL SERVICES AND OTHER RELATED PROGRAMS AND ACTIVITIES TO ACHIEVE THE GOALS OF IMPROVING THE MANNER, PROCESS, ENVIRONMENT, ACCESSIBILITY, TIMING AND OTHER FACTORS INVOLVED IN THE DELIVERY OF PEDIATRIC CLINICAL SERVICES TO ADVANCE THE HEALTH OF THE CHILDREN OF THE REGION. 184439306 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 34 0 1 324 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 4 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X AMY HATCHER 4029556262 8200 DODGE STREET OMAHA NE 68114 JESSICA GOELLER MD CHAIR/DIV CHIEF OF PED ANESTH 40.00 0.00 X X 702328 0 41400 KARI SIMONSEN MD MEMBER/CHAIR OF PEDIATRICS 40.00 0.00 X 640968 0 41400 ZEBULON TIMMONS MD MEMBER/DIV CHIEF OF EMERGENCY 40.00 0.00 X 428309 0 41400 ROBERT CUSICK MD VICE CHAIR/PHYSICIAN 40.00 0.00 X X 841535 0 41400 ANDREW HUANG PACHECO MD MEMBER/PHYSICIAN 40.00 0.00 X 401815 0 41400 ALEISHA NABOWER MD MEMBER/PHYSICIAN 40.00 0.00 X 276729 0 25832 AMY HATCHER TREASURER 1.00 0.00 X X 0 0 0 BRADLEY BRITIGAN MD MEMBER 1.00 0.00 X 0 0 0 CHANDA CHACON MEMBER 1.00 0.00 X 0 0 0 CHRISTOPHER MALONEY MD MEMBER 1.00 0.00 X 0 0 0 DAVID DIAMOND THRU JAN 24 MEMBER 1.00 0.00 X 0 0 0 DAVID MERCER MD MEMBER 1.00 0.00 X 0 0 0 DWIGHT JONES MD MEMBER 1.00 0.00 X 0 0 0 ALAN TINGLEY MD PRESIDENT 40.00 0.00 X 812487 0 41400 CAMILLE HANCOCK FRIESEN MD PHYSICIAN 40.00 0.00 X 1560545 0 41400 ALI IBRAHIMIYE MD PHYSICIAN 40.00 0.00 X 1712456 0 41400 ABDALLA ZARROUG MD DIV CHIEF OF PEDIATRIC SURGERY 40.00 0.00 X 944466 0 41400 RAM KUMAR SUBRAMANYAN MD DIV CHIEF OF CT SURGERY 40.00 0.00 X 1471258 0 41400 TRAVIS KRUSE MD DIV CHIEF OF RADIOLOGY 40.00 0.00 X 884704 0 41400 10677600 0 481232 247 0 1 0 NEBRASKA MEDICINE 988145 NEBRASKA MEDICAL CENTER OMAHA NE 68198 OPERATING AGREEMENT 2706374 COMPHEALTH MED STAFFING (CHG COMPANIES) PO BOX 972651 DALLAS TX 75397 TEMPORARY STAFFING 1589906 UNIV OF NE MEDICAL CENTER 985045 NEBRASKA MEDICAL CENTER OMAHA NE 68198 OPERATING AGREEMENT 1495707 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 TEMPORARY STAFFING 767827 ADVANCED RADIOLOGY OF GRAND ISLAND PC 527 N DIERS AVENUE SUITE 3 GRAND ISLAND NE 68803 RADIOLOGY SERVICES 687500 18 201315 201315 NET PATIENT SERVICE RE 621110 80031176 80031176 CONTRACT REVENUE 621110 29224415 29224415 FACILITY FEE REVENUE 621110 1810798 1810798 FICA INCOME 621110 609836 609836 OTHER DEPARTMENTAL REV 621110 318885 318885 111995110 13694 13694 CONTRACT SEVICES 541900 220655 220655 220655 112430774 112215765 0 13694 X 2558179 2558179 4104173 4104173 105056488 103826507 1229981 7897063 7897063 5217446 5217446 4178376 4131202 47174 3319605 3319605 15292 14492 800 121479 121479 46290499 45350507 939992 2236176 2235575 601 4381204 4030170 351034 706474 701980 4494 838563 838563 1599361 1512693 86668 PROF. BUSINESS EXPENSES 897138 896372 766 SOFTWARE 839753 15757 823996 MEMBERSHIP DUES AND SUB 758683 748931 9752 BANK FEES 182944 36212 146732 437700 323484 114216 191636596 184439306 7197290 0 3202971 7148152 0 0 0 0 14696052 13777508 0 0 0 0 347428 456279 0 0 370364 508895 0 0 0 0 0 0 0 0 0 0 0 0 589295 771686 19206110 22662520 18347685 21474022 0 0 0 0 0 0 0 0 0 0 0 0 0 0 858425 1188498 19206110 22662520 X 0 0 0 0 0 0 19206110 22662520 X -79205822 79205822 X 0 1 X 1 0 X PART-I LINE-12A NEBRASKA PEDIATRIC PRACTICE, INC. (NPP) HAS CHECKED LINE 3 ON THE SCHEDULE A AS THE IRS HAS RECOGNIZED NPP AS A TAX-EXEMPT HOSPITAL UNDER IRC SECTION 501(C)(3) AND AS A HOSPITAL UNDER IRC SECTION 170(B)(1)(A)(III). ALTHOUGH NPP HAS BEEN RECOGNIZED AS A HOSPITAL, IT DOES NOT OWN OR OPERATE AS A LICENSED HOSPITAL. THEREFORE, IT IS APPROPRIATE THAT SCHEDULE H HAS NOT BEEN COMPLETED. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DEFERRED COMPENSATION 269624 CURRENT PORTION OF LEASE PAYMENT 153224 LEASE/LOAN OBLIGATION 765650 1188498 X 109872596 0 109872596 2558178 2558178 112430774 189078418 0 189078418 2558178 2558178 191636596 PART X, LINE 2: NEBRASKA PEDIATRIC PRACTICE (NPP) RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. AS OF DECEMBER 31, 2024 OR 2023, NPP HAS NOT RECORDED ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 2,558,178. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 2,558,178. 0 CHARITY CARE 5237 2558179 FMV CHARITY CARE X X X X 0 0 0 0 0 0 0 0 0 ALI IBRAHIMIYE MD PHYSICIAN 1300468 0 410968 0 1020 0 41400 0 0 0 1753856 0 0 0 CAMILLE HANCOCK FRIESEN MD PHYSICIAN 1426900 0 130784 0 2861 0 41400 0 0 0 1601945 0 0 0 RAM KUMAR SUBRAMANYAN MD DIV CHIEF OF CT SURGERY 1367720 0 102000 0 1538 0 41400 0 0 0 1512658 0 0 0 ABDALLA ZARROUG MD DIV CHIEF OF PEDIATRIC SURGERY 805567 0 137341 0 1558 0 41400 0 0 0 985866 0 0 0 TRAVIS KRUSE MD DIV CHIEF OF RADIOLOGY 730436 0 153413 0 855 0 41400 0 0 0 926104 0 0 0 ROBERT CUSICK MD VICE CHAIR/PHYSICIAN 768482 0 70200 0 2853 0 41400 0 0 0 882935 0 0 0 ALAN TINGLEY MD PRESIDENT 655050 0 148194 0 9243 0 41400 0 0 0 853887 0 0 0 JESSICA GOELLER MD CHAIR/DIV CHIEF OF PED ANESTH 625579 0 75775 0 974 0 41400 0 0 0 743728 0 0 0 KARI SIMONSEN MD MEMBER/CHAIR OF PEDIATRICS 561734 0 74584 0 4650 0 41400 0 0 0 682368 0 0 0 ZEBULON TIMMONS MD MEMBER/DIV CHIEF OF EMERGENCY 384734 0 43148 0 427 0 41400 0 0 0 469709 0 0 0 ANDREW HUANG PACHECO MD MEMBER/PHYSICIAN 249103 0 152440 0 272 0 41400 0 0 0 443215 0 0 0 ALEISHA NABOWER MD MEMBER/PHYSICIAN 254295 0 22185 0 249 0 25832 0 0 0 302561 0 0 0 PART I, LINE 3 COMPENSATION FOR THE PRESIDENT IS PAID BY THE HOSPITAL MEMBER, CHILDREN'S HOSPITAL & MEDICAL CENTER, AN UNRELATED ORGANIZATION, FOR SERVICES PROVIDED TO THE NEBRASKA PEDIATRIC PRACTICE INC. SEE SCHEDULE O NARRATIVE PART VI, LINE 15A FOR ADDITIONAL INFORMATION ON THE PRESIDENT'S COMPENSATION ARRANGEMENT AND REVIEW PROCESS. FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO MEMBERS OF THE CORPORATION: (A) THE BOARD OF REGENTS OF THE UNIVERSITY OF NEBRASKA, A PUBLIC BODY CORPORATE, ACTING ON BEHALF OF THE UNIVERSITY OF NEBRASKA MEDICAL CENTER, COLLEGE OF MEDICINE (THE ACADEMIC MEMBER), AND (B) CHILDREN'S HOSPITAL AND MEDICAL CENTER, A NEBRASKA NONPROFIT CORPORATION (THE HOSPITAL MEMBER). THE MEMBERS RETAIN THE FOLLOWING POWERS, NOTWITHSTANDING ANYTHING IN THESE BYLAWS TO THE CONTRARY: A. IN ACCORDANCE WITH THE BYLAWS, EACH MEMBER SHALL HAVE THE POWER TO APPOINT CERTAIN DIRECTORS OF THE CORPORATION UNDER ARTICLE III, SECTION 2, AND REMOVE CERTAIN DIRECTORS OF THE CORPORATION UNDER ARTICLE II, SECTION 11. B. IN ACCORDANCE WITH THE BYLAWS, THE MEMBERS SHALL HAVE THE POWER TO APPROVE THE APPOINTMENT AND REMOVAL OF THE PERSON DESIGNATED BY THE BOARD OF DIRECTORS AS THE CORPORATION'S EXECUTIVE DIRECTOR. C. THE MEMBERS SHALL HAVE THE POWER TO APPROVE OR REFUSE TO APPROVE ANY AMENDMENT TO THE CORPORATION'S ARTICLE OF INCORPORATION OR THE BYLAWS, OR ANY ACTION REQUIRED TO BE SUBMITTED TO AND APPROVED BY VOTING MEMBERS OF A NONPROFIT CORPORATION UNDER THE NEBRASKA NONPROFIT CORPORATION ACT. D. THE FOLLOWING ACTIONS OF THE CORPORATION ARE SUBJECT TO APPROVAL BY THE MEMBERS: (I) ADOPTION AND ADJUSTMENT OF THE CORPORATIONS ANNUAL BUDGET, CAPITAL EXPENDITURES BUDGET, MISSION STATEMENT, OPERATING PLAN, AND LONG-RANGE PLAN; (II) INCURRENCE OF ASSUMPTION OF DEBT (OTHER THAN TRADE PAYABLES); (III) ADOPTION OF COMPENSATION PLANS; (IV) ASSESSMENTS AGAINST MEMBERS; (V) REORGANIZATION AND TRANSFER OF ASSETS OUTSIDE OF THE ORDINARY COURSE OF BUSINESS; (VI) ESTABLISHMENT OF A SUBSIDIARY OR PARTICIPATION AS A SHAREHOLDER, PARTNER, OR MEMBER OF ANY OTHER ENTITY; (VII) ANY DISTRIBUTION OF CAPITAL OR NET EARNINGS OF THE CORPORATION; (VIII) DISSOLUTION OF THE CORPORATION; AND (IX) ADMISSION OF NEW MEMBERS. THE AFFIRMATIVE APPROVAL OF BOTH MEMBERS IS NECESSARY FOR ANY ACTION OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A SEE NARRATIVE ABOVE FOR FORM 990, PART VI, SECTION A, LINE 6. FORM 990, PART VI, SECTION A, LINE 7B SEE NARRATIVE ABOVE FOR FORM 990, PART VI, SECTION A, LINE 6. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE DISTRIBUTED VIA BOARDVANTAGE TO THE NEBRASKA PEDIATRIC PRACTICE BOARD MEMBERS FOR REVIEW PRIOR TO FILING WITH THE IRS. HOWEVER, SINCE ALL COMPENSATION INFORMATION WILL BE REDACTED FROM THE COPY SENT TO THE BOARD, THE TAXPAYER IS ANSWERING THE QUESTION ON PART VI, LINE 11A "NO". FORM 990, PART VI, SECTION B, LINE 12C NEBRASKA PEDIATRIC PRACTICE HAS A CONFLICT OF INTEREST POLICY WHICH EXISTS TO IDENTIFY AND ETHICALLY RESOLVE CONFLICTS OF INTEREST WHICH MAY EXIST ON THE PART OF DIRECTORS, OFFICERS, AND MEMBERS OF COMMITTEES AS REQUIRED BY STANDARDS PROMULGATED BY THE JOINT COMMISSION, THE INTERNAL REVENUE CODE AND TREASURY REGULATIONS GOVERNING TAX-EXEMPT ORGANIZATIONS, REQUIREMENTS PLACED UPON PROVIDERS BY MEDICARE AND MEDICAID PROGRAM REGULATIONS, AND STATE LAW. AN OFFICER, DIRECTOR, OR COMMITTEE MEMBER WILL BE DEEMED TO HAVE A POTENTIAL CONFLICT OF INTEREST IN A CONTRACT OR TRANSACTION IF HE OR SHE, OR A FAMILY MEMBER, IS A PARTY (OR ONE OF THE PARTIES) CONTRACTING OR DEALING WITH NEBRASKA PEDIATRIC PRACTICE, OR IF HE OR SHE, OR A FAMILY MEMBER, IS A DIRECTOR, OFFICER, OR GENERAL PARTNER IN, OR HAS A FINANCIAL INTEREST IN, THE ENTITY CONTRACTING OR DEALING WITH NEBRASKA PEDIATRIC PRACTICE. ANY POTENTIAL CONFLICT OF INTEREST SHOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD WHENEVER IT ARISES, OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. ANY OFFICER, DIRECTOR, OR COMMITTEE MEMBER HAVING A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. TRANSACTIONS INVOLVING PERSONS WITH CONFLICTS MUST BE APPROVED IN ADVANCE BY A MAJORITY OF DISINTERESTED DIRECTORS. DISINTERESTED DIRECTORS ARE THOSE DIRECTORS HAVING NO DIRECT OR INDIRECT INTEREST IN THE ISSUE OR TRANSACTION. IN ORDER TO APPROVE AN ARRANGEMENT OR TRANSACTION INVOLVING CONFLICTS OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED DIRECTORS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT IS IN NEBRASKA PEDIATRIC PRACTICE'S BEST INTEREST, IS FAIR AND REASONABLE TO NEBRASKA PEDIATRIC PRACTICE AND THAT, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. ALL OFFICERS, DIRECTORS AND COMMITTEE MEMBERS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE A CONFLICT OF INTEREST QUESTIONAIRE UPON INITIALLY JOINING THE BOARDS OF DIRECTORS AND ANNUALLY THEREAFTER. THE CORPORATION'S BOARD OF DIRECTORS SHALL SERVE AS THE CONFLICT REVIEW COMMITTEE, UNLESS IT CHOOSES TO APPOINT A COMMITTEE COMPOSED OF THE DIRECTORS OF THE BOARD TO ASSUME THIS RESPONSIBILITY. WHEN QUESTIONAIRES OR INTERIM DISCLOSURES OF ANY MEMBER OF THE CONFLICT REVIEW COMMITTEE ARE BEING REVIEWED, THE MEMBER BEING REVIEWED SHALL BE EXCUSED FROM THE COMMITTEE'S DELIBERATION AND ACTION. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR, AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF COMPENSATION, TO SUBSTANTIATE THE COMPENSATION OF THE PRESIDENT OF THE CORPORATION AS WELL AS THE PHYSICIANS. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE OF THE HOSPITAL MEMBER'S BOARD OF DIRECTORS. THE INDEPENDENT COMPANY ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPRORPRIATENESS OF EXECUTIVE AND PHYSICIAN PAY LEVELS. THE HOSPITAL MEMBER'S BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G STAFF SUPPORT: PROGRAM SERVICE EXPENSES 29,959,629. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,959,629. CONTRACT PROVIDERS: PROGRAM SERVICE EXPENSES 9,326,238. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,326,238. BILLING FEES: PROGRAM SERVICE EXPENSES 5,603,806. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,603,806. RECRUITMENT: PROGRAM SERVICE EXPENSES 151,645. MANAGEMENT AND GENERAL EXPENSES 40,256. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 191,901. CONSULTING: PROGRAM SERVICE EXPENSES 37,288. MANAGEMENT AND GENERAL EXPENSES 321,051. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 358,339. COLLECTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 505,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 505,903. OTHER: PROGRAM SERVICE EXPENSES 271,901. MANAGEMENT AND GENERAL EXPENSES 72,782. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 344,683. FORM 990, PART XI, LINE 9: SUPPORT FROM HOSPITAL MEMBER 79,205,822. FORM 990, PART XI, LINE 9 SUPPORT FROM HOSPITAL MEMBER FOR CASH FLOW - REASON FOR NO FUND BALANCE AT END OF YEAR: $79,205,823.